摘要
局部晚期乳腺癌(LABC)是乳腺癌中具有较高异质性和治疗挑战性的类型,在局部治疗和系统治疗的方案选择中都存在若干值得探讨的热点问题。在传统分期定义基础上,精准判断LABC患者的手术可行性,是制定精准治疗策略的前提。对于可手术LABC患者,推荐根治性手术作为首选治疗策略,而非惯性选择新辅助治疗,以避免耐药风险增加或病情进展导致手术机会丧失。对于初诊不可手术的LABC,新辅助治疗的目标在于降期后获得手术机会,手术依然是LABC治疗的核心手段。新辅助治疗是LABC患者的重要治疗手段,但并非必须的筛选手段。近年来,系统治疗药物的飞速发展为LABC患者的辅助治疗和强化治疗提供了更多选择,由此也产生了治疗时机选择的争议性问题。本文结合LABC相关的临床研究进展,探讨LABC诊断和治疗选择中的热点问题。
Locally advanced breast cancer(LABC)is a subtype characterized by high heterogeneity and significant therapeutic challenges.There are some unresolved issues in its local and systemic treatment.Based on traditional staging criteria,precise assessment of surgical feasibility is fundamental to formulating refined treatment plans.For patients with operable LABC,radical surgery is recommended as the primary strategy,rather than routinely opting for neoadjuvant therapy.This approach mitigates risks of increased drug resistance or disease progression that may compromise surgical opportunities.In cases of initially inoperable LABC,neoadjuvant therapy aims to achieve tumor downstaging to enable surgery which remains central to LABC management.Even neoadjuvant therapy serves as a critical treatment modality,it is not an obligatory screening step.Recent advances in systemic therapeutics have expanded options for adjuvant and intensive treatment,and sparked debates regarding optimal timing of interventions.This article synthesizes clinical research progress in LABC to explore current controversies in its diagnosis and therapeutic decision-making.
作者
徐颖
宋雨
黄欣
周易冬
孙强
林燕
Xu Ying;Song Yu;Huang Xin;Zhou Yidong;Sun Qiang;Lin Yan(Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华乳腺病杂志(电子版)》
2025年第3期139-144,共6页
Chinese Journal of Breast Disease(Electronic Edition)
基金
北京协和医院中央高水平医院临床科研专项(2022-PUMCH-C-066)。
关键词
乳腺肿瘤
外科手术
精准医疗
强化治疗
Breast neoplasms
Surgical procedures,operative
Precision medicine
Intensive therapy
